Keeping Obstetrics Local Act

This bill aims to keep birthing care close to home, especially in rural areas and communities that rely on Medicaid and CHIP. It raises state payments for labor and delivery at targeted hospitals and adds more federal dollars to help cover those costs. States must also study what it actually costs to run maternity care and get help to gather data, so smaller rural hospitals aren’t left behind. The extra support also applies to CHIP, and these payments won’t count against other federal limits on hospital funding .

It expands coverage and access for pregnant and postpartum people. States must provide 12 months of full Medicaid and CHIP coverage after pregnancy (not just pregnancy-related care) and give presumptive coverage so care can start right away while paperwork is processed . States can set up “maternity health homes” to coordinate care during pregnancy and the year after birth, with planning grants and clear standards, starting in 2028 . The federal government will issue guidance to help states cover services from doulas and midwives, and it boosts support for screening for depression and anxiety during and after pregnancy . To prevent care gaps when hospitals close, the U.S. Public Health Service can deploy clinicians to places with an “urgent maternal health” need, and states must make it easier for out‑of‑state maternity providers to join Medicaid. Hospitals must give the community 180 days’ notice before closing an obstetrics unit, share an impact report, and states must post those reports; the bill also increases collection of labor‑and‑delivery data .

• Who is affected

  • Pregnant and postpartum people using Medicaid or CHIP.
  • Rural and safety‑net hospitals that provide labor and delivery care.
  • Doulas, midwives, and other maternal health providers.
  • Hospitals planning to close obstetrics units, and the communities they serve.
  • Maternity providers near state borders who treat patients across state lines.

• What changes

  • Higher Medicaid/CHIP payments for maternity care at targeted hospitals, with more federal matching dollars to pay for it .
  • 12 months of full postpartum coverage and required presumptive eligibility for pregnant people .
  • Optional “maternity health homes” to coordinate care; federal planning grants; guidance to cover doula and midwife services; and added support for mental‑health screening .
  • Emergency workforce deployments to areas with urgent maternal care needs and simpler enrollment for neighboring‑state providers .
  • 180‑day public notice before OB unit closures and more public data on local labor‑and‑delivery services.

• When

  • Higher minimum Medicaid payment rates for maternity care begin in fiscal year 2027, with extra federal help to cover the increase .
  • Planning grants for states begin in 2027.
  • Added support for perinatal and postpartum depression/anxiety screening takes effect about 1 year after enactment.
  • 12‑month postpartum coverage and presumptive eligibility generally start the first calendar quarter beginning at least 1 year after enactment; states may start earlier .
  • Maternity health homes and streamlined out‑of‑state provider enrollment start January 1, 2028; federal guidance on cross‑state enrollment is due by then .
  • The 180‑day OB‑closure notice requirement begins 180 days after enactment.